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a \�,o �s �0 (� l APPLICATION FOR SANITATION FERMI' Permit No. -----7Y / (Complete in Duplicate) �11�'�''+� Date Issued ---- lli+�__ Applicakion is hereby made to the Son Joaquin Local Health District for a/pte9rmii`t"t�o construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION,_ '11 __ i --( ------ 0 - ------------------------ Owner's Name.----,D._"yZV-----------1/ '_ ?_ ----------------------------------------------------------- -------- ------- -------------- Phone--------•-----------------------•--- Address__.......... ........./16Q---------el_a4l Contractor's Name_____ _: . �Crs�9� -Y ------ __..`_-0 �� S ---------- -------------------------------------------------------------I Phone--------...---------------•--- Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J___ Number of bedrooms _ 2_ Number of baths ._1_--- Lot size ___?�_.___-X-C---9, Water Supply: Public system ❑ Community system ❑ Private U�J—Depth to Water Table _0? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [] No � New Construction: Yes Pq No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank. Distance from nearest well_________________Distance from foundation------------ Material-----------------------------------------__--__. ❑ of compartments-...-- ---.Size--------------------------------Liquid depth------------- - ----------Capacity---------------------- Disposal Field: Distance from nearest well____ from foundation____-Id -_____.Distance to nearest lot line,----.17__. Number of lines______________ Length of each line___,_-_-_3.f• _�t___._.Width of french______-.�V--°...__.___..___ Type or filter materiaL_,/_a�-$12..._Depth of filter material__.-_ _-�__________-Total length___._-._ -�}______________________ r Seepage Pit: Distance to nearest well../- ---__+____._Distant fr #4µn tion_- !A_ .-_Distance,to nearest lot Number of pits......J_----------Lir ing materialAA�__'__/` iz�e: Diameter------ - -- ----Depth-------`r .fr_.*....... ' Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material__.____------_---------_____________ ❑ Size: Diameter- ------ ------ -- ----Depth----------------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------••---------------. ❑ Distance to nearest lot line------------------------------------- ----------_-_---------- Remodeling and/or repairing (describe _ _. __ } �. - � Q- 'Liz-- ------------------------------------ ---------- -------------------------------------------------------•---------------------------------------------------------------------------------------------------------------- ------------------------------------- ---- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed)- P- -' C ---------- - (Owner and/or Contractor) ------------------------------ BY� -------------------------------------(Title)--- - -------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------- X - ---------------••------- DATE REVIEWEDBY--------------------------------------- - ------•- -------------------------------------- DATE---------- ---- BUILDING PERMIT ISSUED------------ - - ------------------------------------------.._._- DATE.------------- c Alterations and/or recommendations:--------- ----------------------------------••-•--------••------------------------- •------- ---------------- ---e ----------------------- ��. �. ----------- -----------•------------------- ----------------------------------------- -------------- -------- --- -----------------------------�).---------------------------------------------------------------------- ----- -------------------------- FINAL INSPECTION BY---------- ---- --- Date-- - --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Man+eoa, California Tracy, California Er--9---21A 145446 ATWo 12.54